European Journal of Medical Research 2013, 18:33
doi:10.1186/2047-783X-18-33

Published: 28 September 2013

Abstract

Background

In recent years, many advances in pancreatic surgery have been achieved. Nevertheless,
the rate of pancreatic fistula following pancreatic tail resection does not differ
between various techniques, still reaching up to 30% in prospective multicentric studies.
Taking into account contradictory results concerning the usefulness of covering resection
margins after distal pancreatectomy, we sought to perform a systematic, retrospective
analysis of patients that underwent distal pancreatectomy at our center.

Methods

We retrospectively analysed the data of 74 patients that underwent distal pancreatectomy
between 2001 and 2011 at the community hospital in Neuss. Demographic factors, indications,
postoperative complications, surgical or interventional revisions, and length of hospital
stay were registered to compare the outcome of patients undergoing distal pancreatectomy
with coverage of the resection margins vs. patients undergoing distal pancreatectomy
without coverage of the resection margins. Differences between groups were calculated
using Fisher’s exact and Mann–Whitney U test.

Results

Main indications for pancreatic surgery were insulinoma (n=18, 24%), ductal adenocarcinoma (n=9, 12%), non-single-insulinoma-pancreatogenic-hypoglycemia-syndrome (NSIPHS) (n=8, 11%), and pancreatic cysts with pancreatitis (n=8, 11%). In 39 of 74 (53%) patients no postoperative complications were noted. In detail we found that 23/42
(55%) patients with coverage vs. 16/32 (50%) without coverage of the resection margins had no postoperative complications. The
most common complications were pancreatic fistulas in eleven patients (15%), and postoperative bleeding in nine patients (12%). Pancreatic fistulas occurred in patients without coverage of the resection margins
in 7/32 (22%) vs. 4/42 (1011%) with coverage are of the resection margins, yet without reaching statistical significance.
Postoperative bleeding ensued with equal frequency in both groups (12% with coverage versus 13% without coverage of the resection margins). The reoperation rate was 8%. The hospital stay for patients without coverage was 13 days (5–60) vs. 17 days (8–60)
for patients with coverage.

Conclusions

The results show no significant difference in the fistula rate after covering of the
resection margin after distal pancreatectomy, which contributes to the picture of
an unsolved problem.